Product Complaint Form

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Product Complaint Form

PLEASE FILL OUT ALL REQUIRED FIELDS

Fields marked with * are required,
or fill out a PDF instead and send it as an attachment to ecom1@medasia.com.ph

Customer Name

Address

Contact Person

Position

Department

Telephone

Phone Number

E-mail Address

Brand of Product

Lot Number

Type / Kind of Product

Product Code

Number of Piece Involved

Size(s)

Nature of Defect: (Please describe in a clear and concise manner)

Your complaint has been submitted!

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